超微血管成像和超声造影对乳腺癌病灶内微血流及超微血管的评价及其联合诊断价值

doi:10.7517/issn.1674-0475.190818

摘要/Abstract

摘要： 本文探讨了超微血管成像（SMI）和超声造影（CEUS）对乳腺癌病灶内微血流及超微血管的评价，及其联合检查对乳腺癌的诊断价值。选取2017年6月~2019年3月我院收治的经手术病理证实的乳腺癌患者106例（106个肿块）作为研究对象，所有患者术前均完成彩色多普勒血流显像（CDFI）、CEUS及SMI检查。比较SMI、CEUS对乳腺癌的诊断准确率及对病灶内血流信号、穿支血管的显示情况。结果显示，106例乳腺癌（106个肿块）中，SMI和CEUS对乳腺癌的诊断准确率分别为79.25%、83.96%，两者比较差异无统计学意义（P>0.05）；SMI联合CEUS检查对乳腺癌的诊断准确率为96.23%，明显高于单一SMI或CEUS的诊断准确率（P<0.05）。在血流信号显示上，SMI检出不丰富血流信号、丰富血流信号分别为64个、42个；CEUS表现为低增强64个、等增强及高增强为42个；SMI和CEUS评价乳腺癌病灶内微血管及血流供应情况具有较好的一致性（P<0.05）。在穿支血管显示上，SMI检出44个、CDFI检出34个，SMI能够清晰检出CDFI不能检出的穿支血管10个。表明SMI和CEUS诊断乳腺癌病灶内微血管及血流供应情况具有较好的一致性，对乳腺癌均有较高的诊断价值，二者联合检查有助于提高乳腺癌的诊断准确率。

关键词: 乳腺癌, 超微血管成像, 超声造影, 血流信号, 穿支血管

Abstract: This paper is to investigate the diagnostic value of superb microvascular imaging (SMI) and contrast enhanced ultrasound (CEUS) in microblood flow and ultramicro-blood vessels in breast cancer. 106 cases (106 masses) of breast cancer confirmed by surgery and pathology in our hospital from June 2017 to March 2019 were selected as the study subjects.All patients underwent color Doppler flow imaging (CDFI), CEUS and SMI before operation. The diagnostic accuracy of SMI and CEUS in breast cancer and the display of blood flow signals and perforating vessels in the lesions were compared. The results show that among 106 cases of breast cancer (106 masses), the diagnostic accuracy of SMI and CEUS for breast cancer was 79.25% and 83.96%, respectively, with no significant difference (P>0.05). The diagnostic accuracy of SMI combined with CEUS in breast cancer was 96.23%, which was significantly higher than that of single SMI or CEUS (P<0.05). On the display of blood flow signals, 64 blood flow signals were not rich and 42 blood flow signals were rich detected by SMI. CEUS showed low enhancement in 64 cases, equal enhancement and high enhancement in 42 cases respectively. SMI and CEUS had good consistency in evaluating microvascular and blood flow in breast cancer lesions (P<0.05). On the display of perforating vessels, 44 cases were detected by SMI and 34 cases by CDFI. SMI could clearly detect 10 perforating vessels which could not be detected by CDFI. Research shows:SMI and CEUS have good consistency in the diagnosis of microvascular and blood supply in breast cancer lesions, and have high diagnostic value for breast cancer. The combined examination of SMI and CEUS is helpful to improve the diagnostic accuracy of breast cancer.

Key words: breast cancer, superb microvascular imaging, contrast enhanced ultrasound, blood flow signal, perforator vessel

丁敏侠, 严婷. 超微血管成像和超声造影对乳腺癌病灶内微血流及超微血管的评价及其联合诊断价值[J]. 影像科学与光化学, 2020, 38(1): 144-149.

DING Minxia, YAN Ting. The Diagnostic Value of Superb Microvascular Imaging and Contrast Enhanced Ultrasound in Microblood Flow and Ultramicro-blood Vessels in Breast Cancer[J]. Imaging Science and Photochemistry, 2020, 38(1): 144-149.

参考文献

[1] 焦学昌, 何小雪.乳腺癌超声征象与病理组织学类型的相关性[J].实用癌症杂志, 2019, 34(6):915-918. Jiao X C, He X X. The correlation between ultrasonographic features of breast cancer and histopathological types[J]. Journal of Applied Cancer, 2019, 34(6):915-918.
[2] Dong T. Early response assessed by contrast-enhanced ultrasound in breast cancer patients undergoing neoadjuvant chemotherapy[J]. Ultrasound Quarterly, 2018, 34(2):84-87.
[3] 张春征, 王芳, 红华.超微血管成像在诊断乳腺肿瘤中应用及研究进展[J].中华实用诊断与治疗杂志, 2018, 32(4):414-416. Zhang C Z, Wang F, Hong H. Application and research progress of ultramicro-angiography in the diagnosis of breast tumors[J]. Chinese Journal of Practical Diagnosis and Treatment, 2018, 32(4):414-416.
[4] 朱慧, 徐卫平, 陈红燕, 等.超声造影联合超微血管显像对乳腺癌微血管的评价[J].中国临床医学影像杂志, 2016, 27(6):390-392. Zhu H, Xu W P, Chen H Y, et al. Evaluation of microvessels in breast cancer by contrast-enhanced ultrasound combined with ultramicro-vascular imaging[J]. Chinese Journal of Clinical Imaging, 2016, 27(6):390-392.
[5] Cunningham A T, Salzman B, Sifri R. Schonberg:overutilization of breast cancer screening in the US[J]. Journal of General Internal Medicine, 2018, 33(11):1826-1826.
[6] 王志民, 曹伟, 杜月明, 等.常规超声、超声弹性成像及超声增强造影对乳腺癌的诊断价值比较[J].癌症进展, 2018, 16(14):1734-1737. Wang Z M, Cao W, Du Y M, et al. Comparison of diagnostic value of conventional ultrasound, ultrasound elastography and contrast-enhanced ultrasound in breast cancer[J]. Cancer Progression, 2018, 16(14):1734-1737.
[7] 徐玮.超声造影诊断早期乳腺癌敏感性和特异性分析[J].湖南师范大学学报(医学版), 2019, 16(1):53-56. Xu W. Sensitivity and specificity of contrast-enhanced ultrasound in the diagnosis of early breast cancer[J].Journal of Hunan Normal University (Medical Edition), 2019, 16(1):53-56.
[8] Saracco A, Szabó B K, Tánczos E, et al. Contrast-enhanced ultrasound (CEUS) in assessing early response among patients with invasive breast cancer undergoing neoadjuvant chemotherapy[J]. Acta Radiologica, 2017, 58(4):394-402.
[9] 周霖珺, 陈曼.40岁以下乳腺癌的超声造影表现[J].中国超声医学杂志, 2018, 34(2):120-122. Zhou L J, Chen M. Contrast-enhanced ultrasonography of breast cancer under 40 years old[J]. Chinese Journal of Ultrasound Medicine, 2018, 34(2):120-122.
[10] 吴芳, 成静, 马婷, 等.不同分子分型乳腺癌的超声造影特征分析[J].临床超声医学杂志, 2019, 21(1):1-4. Wu F, Cheng J, Ma T, et al. Contrast-enhanced ultrasound features of breast cancer with different molecular types[J]. Journal of Clinical Ultrasound Medicine, 2019, 21(1):1-4.
[11] 谢嘉楠, 黄晓玲.超微血管成像技术诊断乳腺疾病的应用进展[J].中国介入影像与治疗学, 2017, 14(10):644-647. Xie J N, Huang X L. Advances in ultrasound angiography in the diagnosis of breast diseases[J]. Interventional Imaging and Therapy in China, 2017, 14(10):644-647.
[12] 张茂山, 陈翠京, 张彦, 等.超声弹性成像与微血管成像在乳腺肿块中的诊断价值[J].军事医学, 2018, 42(6):442-445,449. Zhang M S, Chen C J, Zhang Y, et al. Diagnostic value of ultrasound elastography and microvascular imaging in breast masses[J].Military Medicine, 2018, 42(6):442-445,449.
[13] Lu R, Meng Y, Zhang Y, et al. Superb microvascular imaging (SMI) compared with conventional ultrasound for evaluating thyroid nodules[J]. BMC Medical Imaging, 2017, 17(1):65.
[14] 董维露, 谭旭艳, 王文平, 等.剪切波弹性成像联合超微血流成像对乳腺癌的诊断价值[J].中国肿瘤外科杂志, 2019, 11(2):107-109. Dong W L, Tan X Y, Wang W P, et al. Diagnostic value of shear wave elastography combined with ultrasonography in breast cancer[J].Chinese Journal of Oncology Surgery, 2019, 11(2):107-109.
[15] 段婧, 赵成茂, 汪学昌, 等.乳腺癌超声造影特征及定量参数的诊断价值研究[J].中国医药, 2019, 14(5):735-737. Duan J, Zhao C M, Wang X C, et al. Diagnostic value of contrast-enhanced ultrasonography and quantitative parameters for breast cancer[J]. Chinese Medicine, 2019, 14(5):735-737.
[16] Zhou S C, Le J, Fan Y W, et al. Study on breast cancer animal model of tumor-micro vessel variation before and after the chemotherapy by contrast enhanced ultrasound quantitative analysis[J]. Pakistan Journal of Pharmaceutical Sciences, 2016, 29(4):1407-1413.